|
6 |
EMQ. Hepatitis C and pregnancy. HCV |
|
7 |
EMQ. Hepatitis E and pregnancy. HEV |
|
8 |
EMQ. Cytomegalovirus and pregnancy.
CMV |
|
9 |
EMQ. Cystic fibrosis |
|
10 |
EMQ. Asymptomatic bacteruria |
6. EMQ.
Hepatitis C and pregnancy. HCV
Abbreviations.
DAAD: Direct-acting, antiviral drug.
HBV: Hepatitis B
virus.
HCV: Hepatitis C
virus.
HCAb: Hepatitis C
antibody.
ROM: Rupture of
membranes.
Scenario 1.
Which, if any, of the following statements are true?
Option list.
|
A |
Hepatitis
kills more people world-wide than HIV |
|
B |
Hepatitis
kills more people world-wide than TB |
|
C |
Hepatitis B
kills more people world-wide that Hepatitis C |
|
D |
Hepatitis B
kills more people world-wide than TB |
|
E |
None of the
above |
Scenario 2.
Which, if any, of the following statements are true in
relation to HCV?
Option list.
|
A |
It is a DNA
virus |
|
B |
It is a RNA
virus |
|
C |
It is a
member of the Flaviviridae family |
|
D |
it is a
member of the Hepadnaviridae family |
|
E |
it is a
member of the Herpesviridae family |
|
F |
most
infections are due to genotypes 1 & 3 |
|
G |
most
infections are due to genotypes 2 & 4 |
Scenario 3.
What is the approximate prevalence of HCV infection in the UK?
Option list.
|
A |
0.1 per
1,000 |
|
B |
0.3 per
1,000 |
|
C |
0.5 per
1,000 |
|
D |
1 per 1,000 |
|
E |
3 per 1,000 |
|
F |
5 per 1,000 |
|
G |
10 per 1,000 |
|
H |
13 per 1,000 |
|
I |
15 per 1,000 |
|
J |
None of the
above |
Scenario 4.
What are the key aspects of the WHO’s Global Health Sector
Strategy in relation to HCV infection?
Option list.
|
A |
elimination
as a as a major public health threat by 2020 |
|
B |
elimination
as a as a major public health threat by 2030 |
|
C |
elimination
as a as a major public health threat by 2040 |
|
D |
reduction in
incidence by 50% by 2030 |
|
E |
reduction in
incidence by 75% by 2030 |
|
F |
reduction in
incidence by 80% by 2030 |
|
G |
reduction in
mortality by 50% by 2030 |
|
H |
reduction in
mortality by 65% by 2030 |
|
I |
reduction in
mortality by 70% by 2030 |
Scenario 5.
What is the incubation period of HCV infection?
Option list.
|
A |
6 weeks |
|
B |
2 months |
|
C |
up to 3
months |
|
D |
up to 4
months |
|
E |
up to 6
months |
|
F |
up to 12
months |
|
G |
none of the
above |
Scenario 6.
What symptoms are most common in acute HCV infection? There is no
option list.
Scenario 7.
How is acute HCV infection diagnosed?
Option list.
|
A |
clinically |
|
B |
presence of HCV
antibody |
|
C |
presence of HCV
RNA |
|
D |
none of the
above |
Scenario 8.
What proportion of those with acute HCV infection are
asymptomatic?
Option list.
|
A |
10% |
|
B |
20% |
|
C |
50% |
|
D |
60% |
|
D |
70% |
|
E |
> 80% |
|
|
|
Scenario 9.
When does continuing infection after initial exposure become
defined as chronic infection?
Option list.
|
A |
after 6
weeks |
|
B |
after 2
months |
|
C |
after 3
months |
|
D |
after 4
months |
|
E |
after 6
months |
|
F |
after 12
months |
|
G |
none of the
above |
Answer. E. After 6 months.
Scenario 10.
Approximately how many of those with acute HCV infection will go
on to chronic infection?
Option list.
|
A |
10% |
|
B |
20% |
|
C |
40% |
|
D |
50% |
|
E |
>50% |
|
F |
>70% |
Scenario 11.
A woman is found to have HCV antibodies. Which, if any, of the
following statements could be true?
Option list.
|
A |
she could
have acute HCV infection |
|
B |
she could
have chronic infection |
|
C |
she could
have had HCV infection that has cleared spontaneously |
|
D |
she could
have had HCV infection that has responded to drug therapy |
|
E |
she could
have a false +ve test result |
|
F |
she could
have chronic HBV infection due to cross reaction with HBcAg |
|
G |
she is
immune to HCV |
|
H |
the
antibodies could result from HCV vaccine |
|
I |
the
antibodies could result from yellow fever vaccine |
|
J |
none of the
above |
Scenario 12.
Which, if any, of the following statements reflect current
thinking about the mechanisms of damage in chronic HCV infection?
Option list.
|
A |
hepatic
damage is proportional to the duration of HCV infection |
|
B |
hepatic
damage is a direct result of HCV replication within hepatocytes |
|
C |
hepatic
damage is proportional to the level of detectable HCV RNA in maternal blood |
|
D |
hepatic
damage is immune-mediated |
|
E |
hepatic
damage is due to progressive biliary tract infection, scarring and stenosis |
|
F |
hepatic
damage mostly occurs in women who abuse alcohol |
|
G |
hepatic
damage is worse in women with co-existing HIV infection |
|
H |
hepatitis D
is end-stage hepatitis C, with cirrhosis and liver failure, ‘D’ originating
from the original name: ‘deadly-stage’ HCV disease |
Scenario 13.
How common is vertical transmission? There is no option list.
Scenario 14.
Which, if any, of the following statements are true in
relation to the hepatitides?.
|
A |
acute
hepatitis is notifiable |
|
B |
chronic
hepatitis is notifiable |
|
C |
hepatitis
A is notifiable as the main route of spread is faecal contamination of food
& water |
|
D |
hepatitis
D is notifiable as the main source of infection is infected food and water |
|
E |
hepatitis
E is notifiable as the main source of infection in the UK is raw or
undercooked pork |
|
F |
none
of the above |
Scenario 15.
What anti-viral treatment is recommended for pregnancy? There is
no option list.
Scenario 16.
Which, if any, of the following are true about Ribavirin?
Option list.
|
A |
it is the
least expensive of the new DAADs for HCV |
|
B |
it is the
least toxic of the new DAADs for HCV |
|
C |
it is the
most effective of the new DAADs for HCV |
|
D |
it is
contraindicated in pregnancy because of fears of teratogenicity |
|
E |
can
cause sperm abnormalities |
|
F. |
can persist
in humans for up to 6 months |
|
G. |
none of the
above |
Scenario 17.
A woman with chronic HCV wishes to breastfeed. What advice would
you give? There is no option list.
Scenario 18.
How is neonatal infection diagnosed? There is no option list.
Scenario 19.
How is neonatal infection treated? There is no option list.
Scenario 20.
Which, if any, of the following conditions is more common in women
with HCV infection?
|
A |
dermatitis herpetiformis |
|
B |
HELLP syndrome |
|
C |
obstetric cholestasis |
|
D |
postnatal depression |
|
E |
thrombocytopenia |
Scenario 21.
By how much is the risk of the condition in question 20 increased
in women with HCV?
Option list.
|
A |
by
a factor of 2 |
|
B |
by
a factor of 5 |
|
C |
by
a factor of 20 |
|
D |
by
a factor of 50 |
|
E |
none
of the above |
Scenario 22.
Which, if any, of the following statements is true about HCV and the Nobel Prize?
Option list.
|
A |
the
Nobel Prize was awarded to Alter, Houghton & Rice in 2020 |
|
B |
the
Nobel Prize was awarded to Alter, Hogg & Rice in 2020 |
|
C |
the
Nobel Prize was awarded to Alter, Houghton & Rees in 2020 |
|
D |
the
Nobel Prize was awarded to Change, Houghton & Rice in 2020 |
|
E |
the
Nobel Prize was awarded to Change, Hogg & Rice in 2020 |
|
F |
the
Nobel Prize was awarded to Change, Hogg & Barleycorn in 2020 |
|
G |
the
Nobel Prize has not been awarded for work on HCV |
7. Hepatitis
E. EMQ.
Question
1.
What is the
most common cause of acute viral hepatitis in the UK?
Option list.
|
A |
hepatitis A virus |
|
B |
hepatitis B virus |
|
C |
hepatitis C virus |
|
D |
hepatitis D virus |
|
E |
hepatitis E virus |
|
F |
herpes simplex virus |
|
G |
HIV |
Question
2.
Which, if any, of
the following are correct about HEV.
Option list.
|
A |
it is a DNA virus |
|
B |
it belongs to the genus Hippieviridae |
|
C |
it belongs to the genus Hepeviridae |
|
D |
it belongs to the genus Hoppieviridae |
|
E |
there are six main genotypes |
|
F |
genotype 3 is the one of greatest importance in the UK |
|
G |
the main reservoir of genotype 3 is intensively-reared
chickens |
|
H |
the main reservoir of genotype 3 is domestic cats |
|
I |
a vaccine exists but is only licensed in Russia |
|
J |
none of the above |
Question
3.
Which, if any, of
the following statements about HEV and pregnancy are true?
Option list.
|
A |
pregnant women are more susceptible to HEV infection |
|
B |
pregnant women are more likely to develop serious
disease that the non-pregnant |
|
C |
the main risk is neonatal death due to vertical
transmission |
|
D |
the main risk is maternal death |
|
E |
the risk of maternal death is highest with infection in
the 1st. trimester |
|
F |
↑ rates of preterm birth have been
reported |
|
G |
↑
rates of stillbirth have been reported |
8. EMQ.
Cytomegalovirus and pregnancy. CMV
Abbreviations.
AI: avidity
index.
CMV: cytomegalovirus.
CNS: central
nervous system.
FGR: fetal
growth restriction.
HIG: hyperimmunoglobulin.
IUFD: intrauterine fetal death.
Scenario 1.
What does the term
“cytomegalovirus” mean?
Option list.
|
A |
it is an unusually large virus |
|
B |
it is the largest known virus |
|
C |
the viral cytoplasm is increased in volume |
|
D |
infected cells are enlarged and have enlarged nuclei |
|
E |
none of the above |
Scenario 2.
Which of the
following terms is used in relation to CMV infected cells?
Option list.
|
A |
almond-eyed |
|
B |
apple of my eye |
|
C |
cross-eyed |
|
D |
doe-eyed |
|
E |
owl-eyed |
Scenario 3.
Which family of
viruses does CMV belong to?
Option list.
|
A |
Adenoviridae |
|
B |
Arachnoviridae |
|
C |
Enteroviridae |
|
D |
Herpesviridae |
|
E |
Poxviridae |
Scenario 4.
What kind of virus
is CMV?
Option list.
|
A |
bacteriophage |
|
B |
DNA virus |
|
C |
RNA virus |
|
D |
none of the above |
Scenario 5.
What is the
structure of the herpes virus?
Option list.
|
A |
double-stranded DNA core, surrounded by three layers:
capsid, tegument and envelope |
|
B |
single-stranded DNA core, surrounded by two layers:
capsid and envelope |
|
C |
double-stranded RNA core, surrounded by three layers:
capsid, tegument and envelope |
|
D |
single-stranded RNA core, surrounded by two layers:
capsid and envelope |
|
E |
none of the above |
Scenario 6.
How many herpes
viruses have been described?
Option list.
|
A |
>1,000 |
|
B |
> 500 |
|
C |
> 250 |
|
D |
> 100 |
|
E |
none of the above. |
Scenario 7.
How many herpes
viruses are of relevance to human infection?
Option list.
|
A |
8 |
|
B |
10 |
|
C |
12 |
|
D |
14 |
|
E |
20 |
Scenario 8.
Write the list of
herpes viruses which affect humans and the conditions they cause?
Option list. There is
none. You have to write your own list.
Scenario
9.
Where does CMV
rank in the list of the most common causes of congenital viral infection?
Option list.
|
A |
1 |
|
B |
2 |
|
C |
3 |
|
D |
4 |
|
E |
5 |
Scenario 10.
Which of the
following statements is the most accurate in relation to CMV?
Option list.
|
A |
CMV can lie dormant after 1ry. infection, usually in
bone marrow |
|
B |
CMV can lie dormant after 1ry. infection, usually in
dorsal root ganglia |
|
C |
CMV can lie dormant after 1ry. infection, usually in
the lungs |
|
D |
CMV can lie dormant after 1ry. infection, usually in
the salivary glands |
|
E |
CMV does not lie dormant after 1ry. infection |
Scenario 11.
Which, if any, of
the following statements is true of CMV & pregnancy in the UK?
Option list.
|
A |
approximately 10-20% of women are immune before their 1st.
pregnancy |
|
B |
approximately 20-30% of women are immune before their 1st.
pregnancy |
|
C |
approximately 30-50% of women are immune before their 1st.
pregnancy |
|
D |
approximately 40-60% of women are immune before their 1st.
pregnancy |
|
E |
none of the above |
Scenario
12.
Which of the
following statements is true in relation to vertical transmission?
Option list.
|
A |
it is mainly transplacental |
|
B |
it is mainly due to feto-maternal haemorrhage |
|
C |
it mainly occurs during labour and delivery |
|
D |
it mainly occurs during lactation |
|
E |
none of the above |
Scenario 13.
What is the approximate
incidence of 1ry. CMV infection in pregnancy?
Option list.
|
A |
< 1% |
|
B |
< 5% |
|
C |
< 7.5% |
|
D |
< 10% |
|
E |
≥ 10% |
Scenario 14.
What is the
biggest source of CMV infection for women of reproductive age?
Option list.
|
A |
contaminated food or water |
|
B |
blood transfusion |
|
C |
infected sexual partner |
|
D |
infected small children |
|
E |
undercooked meat, particularly pork |
Scenario 15.
What proportion of
1ry. maternal CMV infection in pregnancy is asymptomatic?
Option list.
|
A |
up to 10% |
|
B |
11 – 29% |
|
C |
30 – 49% |
|
D |
50 – 79% |
|
E |
80 – 89% |
|
F |
≥ 90% |
Scenario 16.
What is the
approximate prevalence of CMV infection in UK neonates?
Option list.
|
A |
0.10- 0.25% |
|
B |
0.10- 0.50% |
|
C |
0.20- 0.50% |
|
D |
0.20- 1.00% |
|
E |
0.20- 2.25% |
Scenario 17.
Where does CMV
rank in the non-genetic causes of SNHL in children?
Option list.
|
A |
1 |
|
B |
2 |
|
C |
3 |
|
D |
4 |
|
E |
none of the above |
Scenario
18.
When does vertical
transmission carry the greatest risk of inflicting neurological damage on the
fetus?
Option list.
|
A |
with 1ry infection during the 1st. trimester |
|
B |
with 2ry infection during the 1st. trimester |
|
C |
with 1ry infection during the 2nd. trimester |
|
D |
with 2ry infection during the 2nd. trimester |
|
E |
with 1ry infection during the 3rd. trimester |
|
F |
with 2ry infection during the 3rd. trimester |
|
G |
with 1ry infection during labour / delivery |
|
H |
with 2ry infection during labour / delivery |
|
I |
none of the above |
Scenario
19.
What is the risk
of vertical transmission after CMV infection in the immediate preconception
period?
Option list.
|
A |
< 1% |
|
B |
1-5% |
|
C |
6-10% |
|
D |
11-15% |
|
E |
16-20% |
|
F |
21-30% |
Scenario
20.
A fetus is
infected with CMV at the time of highest risk for neurological damage. What is
the approximate upper limit for the risk that the child will have neurological
damage?
Option list.
|
A |
up to 1% |
|
B |
up to 5% |
|
C |
up to 7.5% |
|
D |
up to 10% |
|
E |
up to 12.5% |
|
F |
up to 15% |
|
G |
up to 20% |
|
H |
none of the above |
Scenario
21.
Approximately what
% of cerebral palsy is thought attributable to fetal CMV?
Option list.
|
A |
1% |
|
B |
5% |
|
C |
7.5% |
|
D |
10% |
|
E |
12.5% |
|
F |
15% |
|
G |
20% |
|
H |
25% |
Scenario 22.
Approximately what
% of SNHL is thought attributable to fetal CMV infection?
Option list.
|
A |
1% |
|
B |
5% |
|
C |
7.5% |
|
D |
10% |
|
E |
12.5% |
|
F |
15% |
|
G |
20% |
|
H |
25% |
Scenario 23.
Which, if any, of
the following statements is true of CMV?
Option list.
|
A |
1ry. infection is followed by life-long latent
infection |
|
B |
1ry. infection is followed by life-long latent
infection in a minority of cases |
|
C |
life-long latent infection is characteristic of CMV but
not other herpes viruses |
|
D |
life-long latent infection only occurs after 2ry.
infection |
|
E |
none of the above. |
Scenario 24.
How is 1ry.
maternal CMV infection best diagnosed?
Option list.
|
A |
by the regional laboratory |
|
B |
IgM to IgG conversion |
|
C |
presence of IgM with low avidity IgG |
|
D |
religious conversion |
|
E |
sero-conversion from IgG -ve to IgG +ve |
Scenario 25.
Which, if any, of
the following is true in relation to ‘avidity’ in CMV infection?
Option list.
|
A |
avidity declines directly with the interval from 1ry
infection to the test |
|
B |
avidity is an indirect measure of viral load |
|
C |
avidity measures the determination of the obstetrician
to make a diagnosis |
|
D |
avidity measures the enthusiasm of the laboratory for
maximising the cost of testing |
|
E |
avidity measures the strength of binding of CMV
antibody to the virus |
Scenario 26.
Which, if any, of
the following is true in relation to the CMV ‘avidity index’?
Option list.
|
A |
the AI is the ratio of free: albumin-bound CMV IgG in
maternal serum |
|
B |
the AI is the IgG antibody titre in maternal serum |
|
C |
the AI is the percentage of IgG that is bound to the
antigen |
|
D |
the AI is the amount of IgG bound to the antigen
expressed as micrograms / gram |
|
E |
none of the above |
Scenario 27.
Which, if any, of
the following is true in relation to the CMV ‘avidity index’?
Option list.
|
A |
an AI < 30 is indicative of old infection |
|
B |
an AI < 30 is indicative of recent 1ry infection |
|
C |
an AI < 30 suggests a faulty assay |
|
D |
the AI assay used in the NHS is standard across all
laboratories |
|
E |
none of the above |
Scenario 28.
Which, if any, of the following
statements is true in relation to identifying women at greatest risk of having
a baby with severe congenital infection?
Option list.
|
A |
a low AI < 18 weeks indicates high risk |
|
B |
a high AI < 18 weeks indicates high risk |
|
C |
a high IgM titre indicates low risk |
|
D |
a high IgG titre indicates high risk |
|
E |
none of the above |
Scenario 29.
What is UK policy
in relation to routine screening for CMV in pregnancy?
Option list.
|
A |
routine screening was introduced in 2018 |
|
B |
routine screening is not advocated because of cost |
|
C |
routine screening is not advocated because of the lack
of an accurate test |
|
D |
routine screening is not advocated because of cross-reaction
with EBV |
|
E |
none of the above |
Scenario 30.
What is UK policy
in relation to routine screening of the neonate for CMV?
Option list.
|
A |
routine screening was introduced in 2015 |
|
B |
routine screening is not advocated because of cost |
|
C |
routine screening is not advocated because of the lack
of an accurate test |
|
D |
routine screening is not advocated because of cross-reaction
with EBV |
|
E |
none of the above |
Scenario
31.
Pick the true
statements from the list below.
Option list.
|
A |
avidity testing
is not done on CMV IgM antibodies |
|
B |
CMV IgG is a
maverick and does not play by the usual rules |
|
C |
CMV IgM is a
maverick and does not play by the usual rules |
|
D |
CMV IgG
persists for many years |
|
E |
CMV IgM
persists for 1 year or more |
|
F |
none of the
above |
Scenario
32.
A woman has been
shown to have had CMV infection in pregnancy. It is decided to check for
evidence of fetal infection. What does SIP56 say is the mainstay of diagnosing
fetal CMV infection.?
Option list.
|
A |
amniocentesis and PCR for evidence of CMV |
|
B |
amniocentesis and electron microscopy for evidence of
CMV |
|
C |
amniocentesis and light microscopy for evidence of CMV |
|
D |
amniocentesis and viral culture |
|
E |
MRI |
|
F |
ultrasound – abdominal |
|
G |
ultrasound - transvaginal |
Scenario
33.
A woman has been
shown to have had CMV infection in pregnancy. Which, if any of the following
statements best describe the role of MRI scanning in assessing the fetus? This
is not a true EMQ as more than one statement may be true.
Option list.
|
A |
it should be offered in conjunction with ultrasound |
|
B |
it should be offered if ultrasound examination suggests
fetal infection |
|
C |
it should be offered if ultrasound examination does not
suggest fetal infection |
|
D |
it should be offered if there is sufficient funding to
pay for it |
|
E |
the role of MRI scanning is not yet clear |
|
F |
none of the above |
Scenario 34.
A pregnant woman
is HIV+ve? Which of the following statements is true?
Option list.
|
A |
the risk of vertical transmission in pregnancy is ↑ |
|
B |
the risk of vertical transmission in pregnancy is ↓ |
|
C |
the risk of vertical transmission in pregnancy is the
same as in HIV-ve women |
Scenario 35.
A pregnant woman
is HIV+ve? Which of the following statements is true?
Option list.
|
A |
her neonate is at ↑
risk of acquiring CMV perinatally |
|
B |
her neonate is at ↓
risk of acquiring CMV perinatally |
|
C |
her neonate is at normal risk of acquiring CMV perinatally |
|
D |
none of the above |
Scenario
36.
A pregnant woman
is HIV+ve? Her neonate is +ve for both CMV and HIV. Which of the following
statements is true?
Option list.
|
A |
the child has a ↓
risk of HIV progression and ↓
risk of CNS damage from CMV |
|
B |
the child has a ↓
risk of HIV progression and ↑
risk of CNS damage from CMV |
|
C |
the child has a ↓
risk of HIV progression and normal risk of CNS damage from CMV |
|
D |
the child has an ↑
risk of HIV progression and ↓
risk CNS damage from CMV |
|
E |
the child has an ↑
risk of HIV progression and ↑
risk CNS damage from CMV |
|
F |
the child has an ↑
risk of HIV progression and normal risk of CNS damage from CMV |
|
G |
the child has a normal risk of HIV progression and ↓ risk of CNS damage from CMV |
|
H |
the child has a normal risk of HIV progression ↑ risk of CNS damage from CMV |
|
I |
the child has a normal risk of both HIV progression and
CNS damage from CMV |
Scenario
37.
Which of the
following treatments in pregnancy is of proven efficacy and safety in reducing
the risk of vertical transmission to the fetus?
Option list.
|
A |
acyclovir |
|
B |
CMV vaccine |
|
C |
ganciclovir |
|
D |
HIG |
|
E |
valaciclovir |
|
F |
none of the above |
TOG CPD
Comprehensive review and update of
cytomegalovirus infection in pregnancy
Regarding cytomegalovirus (CMV),
1. it is a double-stranded RNA herpes
virus. True False
2. it is the commonest congenital viral
infection in
the developed world. True False
3. prevalence is most common in social
class V. True False
Regarding CMV morbidity,
4. it is the leading genetic cause of
sensorineural deafness. True False
5. maternal infection occurring in the
third
trimester carries the highest risk to
the
fetus. True False
6. previous infection confers complete
future
immunity to the mother. True False
Regarding feto-maternal transmission of
CMV,
7. there is good evidence to suggest
that
gestational age has no apparent influence
on
risk of transmission. True False
8. breastfeeding is a route of
transmission. True False
9. for healthy mature babies, an
infection with
the CMV through breastmilk does not pose
significant danger. True False
10. transmission can be reduced by
appropriate
hand washing after nappy changes and
exposure to bodily fluids, avoiding
kissing
young children on mouth and cheeks and
by
avoiding sharing food, drinks or
utensils with
young children. True False
11. primary infection, reactivation and
reinfection
with different CMV strains during pregnancy
has been shown to lead to congenital
CMV. True False
Regarding maternal CMV in pregnancy,
12. diagnosis of maternal CMV based on
symptoms is reliable with over 70% of
women
presenting with classic symptoms. True False
13. viral reactivation is more common in
HIV
positive pregnant women. True False
Regarding diagnosis of CMV infection in
pregnancy,
14. seroconversion of CMV specific
immunoglobulin G (IgG) in paired acute
and
convalescent sera is diagnostic of a new
acute infection. True False
15. When prepregnancy status is unknown,
detection of immunoglobulin M (IgM)-
specific antibody is diagnostic of
primary infection. True False
16. IgM serology is imprecise for
determining
primary infection as it has been shown
to
remain positive for up to a year
following
acute infection. True False
17. The presence of IgG and IgM CMV
antibodies
with low CMV antibody avidity is
diagnostic
of primary infection. True False
Concerning congenital CMV infection,
18. 85% are asymptomatic at birth. True False
19. 30% of affected infants will develop
neurological sequelae. True False
20. 15% of infants born to mothers with
recurrent
CMV infection are overtly symptomatic. True False
Comprehensive review and update
of cytomegalovirus infection in pregnancy.
These derive from the TOG
article by Navti et al. The article is from 2016 and is open-access.
TOG. Volume
18, Issue 4 October 2016 Pages 301–7.
Some of the questions are badly
written – I would expect exam questions to be better.
Regarding cytomegalovirus
(CMV),
1. it is a double-stranded RNA herpes virus. True False
2. it is the commonest congenital viral
infection in the developed world. True False.
3. prevalence is most common in social class
V. True False
Regarding CMV morbidity,
4. it is the leading genetic cause of
sensorineural deafness. True False
5. maternal infection occurring in the 3rd.
trimester carries the highest risk to the fetus. True False
6. previous infection confers complete future
immunity to the mother. True False
Regarding feto-maternal transmission of CMV,
7. there is good evidence to suggest that
gestational age has no apparent influence on risk of transmission. True False
8. breastfeeding is a route of transmission. True False
9. for healthy mature babies, an infection
with the CMV through breastmilk does not pose significant danger. True False
10. transmission can be reduced by appropriate
hand washing after nappy changes and exposure to bodily fluids, avoiding
kissing young children on mouth and cheeks and by avoiding sharing food, drinks
or utensils with young children. True False
11. primary infection, reactivation and
reinfection with different CMV strains during pregnancy has been shown to lead
to congenital CMV. True False
Regarding maternal CMV in pregnancy,
12. diagnosis of maternal CMV based on symptoms
is reliable with over 70% of women presenting with classic symptoms. True False 13. viral reactivation is more common in HIV positive pregnant
women. True False
Regarding diagnosis of CMV infection in pregnancy,
14. seroconversion of CMV specific immunoglobulin
G (IgG) in paired acute and convalescent sera is diagnostic of a new acute
infection. True False
15. When prepregnancy status is unknown,
detection of immunoglobulin M (IgM)- specific antibody is diagnostic of primary
infection. True False
16. IgM serology is imprecise for determining
primary infection as it has been shown to remain positive for up to a year
following acute infection. True
17. The presence of IgG and IgM CMV antibodies
with low CMV antibody avidity is diagnostic of primary infection. True False
Concerning congenital CMV infection,
18. 85% are asymptomatic at birth. True False
19. 30% of affected infants will develop
neurological sequelae. True False
20. 15% of infants born to mothers with recurrent
CMV infection are overtly symptomatic.
True False
9. EMQ.
Cystic fibrosis. There is no option list to
make you work harder!
Scenario
1. A woman is 8 weeks pregnant and a carrier of CF. Her husband is
Caucasian. What is the risk of the child having CF?
Scenario
2. A healthy woman attends for pre-pregnancy counselling. Her brother has
CF. Her husband is Caucasian and has a negative CF screen. What is the risk of
them having a child with CF?
Scenario
3. A healthy woman is a carrier of CF. She attends for pre-pregnancy
counselling. Her husband has CF. What is the risk of them having a child with
CF?
Scenario
4. A healthy woman attends for pre-pregnancy counselling. Her sister has
had a child with CF. What is her risk of being a carrier?
Scenario
5. A woman attends for pre-pregnancy counselling. Her mother has CF.
What is the risk that she is a carrier?
Scenario
6 . A woman attends for pre-pregnancy counselling. Her mother has CF.
The partner’s risk of being a carrier is 1 in X. What is the risk that
she will have a child with CF?
Scenario
7. A healthy Caucasian woman is 10 weeks pregnant. Her husband is a carrier
of CF. Which test would you arrange?
Scenario
8. A woman attends for pre-pregnancy counselling. She has read about
diagnosing CF using cffDNA from maternal blood. Is it possible to test for CF
in this way?
Scenario
9. A woman and her husband are carriers of CF. What is the risk of an
affected child?
Scenario
10. A woman and her husband are carriers of CF. What can they do to reduce
the risk of having an affected child?
Scenario
11. A woman and her husband are carriers of CF. Can CVS exclude an affected
pregnancy?
Scenario
12. A woman has CF, her husband is a carrier. What is their risk of an
affected child?
Scenario
13. A woman with CF delivers a baby at term. She has been advised not to
breastfeed because her breast milk will be protein-deficient due to
malabsorption. Is this advice correct?
Scenario
14. A woman with CF delivers a baby at term. She has been advised not to
breastfeed because her breast milk will contain abnormally low levels of
sodium. Is this advice correct?
TOG
CPD. 2009. 11. 1. Cystic fibrosis and
pregnancy
These are open access so are produced here.
Regarding cystic fibrosis,
1. here are approximately 8000 people living with
this disease in the UK. True / False
2. the main cause of death is liver disease. True / False
Women with cystic fibrosis
3. have an approximately 50% reduced
fertility. True / False
4. have a life expectancy of approximately 50
years. True / False
With regard to pregnancy in women with cystic fibrosis,
5. their babies usually have an appropriate
birthweight for their gestational age. True / False
6. approximately 70% of babies are born
prematurely. True / False
7. the risk of developing gestational diabetes
is higher than in the general population. True / False
8. the risk of miscarriage is higher than in
the general population. True / False
9. the risk of congenital malformations is
similar to that in women who are carriers. True / False
Women with cystic fibrosis who become pregnant,
10. have a shortened life expectancy compared
with women who do not. True / False
If a woman with cystic fibrosis becomes pregnant, the risk
of the baby being born with cystic fibrosis
11. is 50% if the father carries one of the
common gene mutations for cystic fibrosis. True / False
12. is < 1 in 250 if the father does not carry
any of the common CF mutations. True / False
During pregnancy, a woman with cystic fibrosis
13. should be cared for by a multidisciplinary
team, including a physician and an obstetrician with a special interest in CF
in pregnancy. True / False
14. should have a GTT if she did not have CF-related
diabetes prior to pregnancy. True / False
In pregnant women with cystic fibrosis,
15. the instrumental delivery rate is
approximately 40%. True / False
16. the use of epidural analgesia during delivery
is contraindicated. True / False
17. the risk of poor pregnancy outcome increases
if the FEV1 is < 70%. True / False
Post- delivery in women with cystic fibrosis
18. breastfeeding is contraindicated because of
the high sodium content of breast milk. True / False
Which of the following statements about cystic fibrosis are correct?
19. Menarche in girls with CF occurs at the same
time as in unaffected girls. True / False
20. Fertility in women with CF is affected to the
same extent as it is in men with CF. True / False
10. EMQ.
Asymptomatic bacteruria
Question
1. What is the
definition of ASB?
Option list.
|
A |
> 1,000,000 colonies per mL on MSU |
|
B |
> 100,000 colonies per mL on MSU |
|
C |
> 10,000 colonies per mL on MSU |
|
D |
> 1,000 colonies per mL on MSU |
|
E |
> 1,000,000 organisms per mL on MSU |
|
F |
> 100,000 organisms per mL on MSU |
|
G |
> 10,000 organisms per mL on MSU |
|
H |
> 1,000 organisms per mL on MSU |
|
I |
none of the above |
Question
2.
Which, if any of
the following reflect NICE’s advice re
routine screening for ASBIP?
Option list.
|
A |
routine screening should be offered early in pregnancy |
|
B |
screening should be by culture of a MSU |
|
C |
screening by dipstick testing for nitrites and leukocyte
esterase is acceptable as an alternative to MSU screening |
|
D |
routine screening is not recommended |
|
E |
talk of urine is indelicate and ill-suited to genteel
discourse so please desist |
Question
3.
Which, if any of
the following reflect the NSC’s advice re
screening for ASBIP?
Option list.
|
A |
routine screening should be offered early in pregnancy |
|
B |
screening should be by culture of a MSU |
|
C |
screening by dipstick testing for nitrites and
leukocyte esterase is acceptable as an alternative to MSU screening |
|
D |
routine screening is not recommended |
|
E |
talk of urine is indelicate and ill-suited to genteel
discourse |
Question 4.
Which, if any, of
the following are proven to be more likely in those with ASBIP?
Option list.
|
A |
chorioamnionitis |
|
B |
cystitis |
|
C |
endometritis |
|
D |
↑
perinatal mortality |
|
E |
LBW |
|
F |
learning difficulty |
|
G |
fetal anaemia |
|
H |
maternal anaemia |
|
I |
premature birth |
|
J |
pyelonephritis |
|
K |
schizophrenia |
Question
5.
What was the main
justification for routine screening for ASBIP?
Option list.
|
A |
it reduces the risk of cystitis |
|
B |
it reduces the risk of premature labour |
|
C |
it reduces the risk of IUGR |
|
D |
it reduces the risk of pyelonephritis |
|
E |
the laboratory staff like to be busy |
|
F |
none of the above. |
Question
6.
Which of the
following statements is correct about leukocyte esterase?
Option list.
|
A |
LE is a sensitive indicator of UTI |
|
B |
LE derives from inflamed bladder mucosa |
|
C |
LE derives from bacteria killed by leukocytes |
|
D |
LE testing is an acceptable method of screening for ASB |
|
E |
a +ve urine LE test usually leads to testing of a MSU |
|
F |
none of the above |
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